Drug therapy for treatment and chronic maintenance therapy of AIDS-associated histoplasma capsulatum infections in adults and adolescents

Preferred therapy for moderately severe to severe disseminated disease

Induction therapy (for 2 weeks or until clinically improved)

• Liposomal amphotericin B at 3 mg/kg IV daily

Maintenance therapy

• Itraconazole 200 mg orally 3 times daily for 3 days, then twice daily

Preferred therapy for less severe disseminated disease

Induction and maintenance therapy

• Itraconazole 200 mg orally 3 times daily for 3 days, then 200 mg orally twice daily

Duration of therapy: at least 12 months

Preferred therapy for meningitis

Induction therapy (4-6 weeks)

• Liposomal amphotericin B 5 mg/kg IV daily

Maintenance therapy

• Itraconazole 200 mg orally 2-3 times daily for ≥1 year and until resolution of abnormal CSF findings

Preferred therapy for long-term suppression therapy

In patients with severe disseminated or CNS infection and in patients who relapse despite appropriate therapy (CIII)

• Itraconazole 200 mg orally daily

Alternative therapy moderately severe to severe disseminated disease

Induction therapy (for 2 weeks or until clinically improved)

• Amphotericin B lipid complex 5 mg/kg IV daily
• Amphotericin B deoxycholate 0.7 mg/kg IV daily^¶

Maintenance therapy

Same as "Preferred therapy"

Itraconazole levels should be obtained in all patients to ensure adequate absorption. Serum concentrations of itraconazole + hydroxyitraconazole should be >1 mcg/mL.

Itraconazole oral solution is preferred over capsule by certain specialists because of improved absorption

Acute pulmonary histoplasmosis in patients with HIV and CD4+ count >300 cells/microL should be managed as non-immunocompromised host